HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Legal Description: (� � ``- AC 5 L
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Property Tax ID#: /!Yin ` voo 06 6 -7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional wor to be performed un er t is permit.-cheCK all mat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
6d
Cost of Construction:$. ���(�� Utilities: _Sewer _Septic Building Height:
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Name
> Name: ti
Address: Company: ��.5� C✓�� I
City: CMe— I �" State:_ Address:
Zip Code: Fax: City: Vr� State:_,�
Phone No. �/a `�l�b�, Zip Code: Fax:
E-Mail: Phone No 7, Je`,�Z - -775
Fill in fee simple Title Holder on next,page(if different E-Mail CA'< ' e-(e- _�,� Cr.)7
from the Owner listed above) State or County License !�G -�,9-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: _ _ . . - - wattie:-----__.___ - - -•: _ _ _ __._._------- --- ---
- Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that.l will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The.following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential.use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
co6mencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for OwnerSignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTYOF , COUNTY OFc o
The forgoing instrument was acknowledged before me The forgoing instrnt was acknowledged before me
this day of �- ,20�( by this Z day of Com, 20L by
I
(Name of person acknowledging) (Name of person acknowledging)
ignature of Notary Public- ate of Florida) Signature of Notary Public- ate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of identification Type of Identification
Produced'V.,_�
LASHAHNAINGRAM ,�, Notary 1Iuouc itac londa
iia�o �j3q, _ U*tes Dec 20,2018
Commission No. ;2°„ ;� N4 �)ubI. State of Florida ommission No. 'y = My coCom S�x /
_. My om .Expires Dec 20.2011 Com isston#FF 177249
Commission#FF 177249 %;FoF F`°��� Bonded through National Notary Assn.
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REVIEWS FRON' Z N SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014